Mental Health Care and the Workplace

There is increasing concern about interaction between mental health problems and workplace-the effect of mental disorders on functioning in workplace and, conversely, effect of workplace factors on occurrence of mental disorders. Such common mental disorders as depression and anxiety are among most frequent causes of occupational disability. Because of its early onset and frequently chronic or recurrent nature, depression is fastest-rising source of disability and leading source of disabled days lived for adults (1). Substantial costs are associated with depressive disorders in form of reduced worker productivity, absenteeism, and disability (2,3). Depression accounts for a steadily increasing proportion of short- and long-term disability claims (4). A recent, rather startling statistic is that the average duration of an active long-term disability claim for depression among healthcare workers in British Columbia is now 46.4 months (5). Several studies have evaluated role of stressful or unsupportive workplaces in genesis or maintenance of psychiatric symptomatology. Researchers have found that certain kinds of workplace stress are associated with a higher frequency of depressive symptoms in employees (6,7). Unfortunately, coordination and communication between mental health care system and workplace have traditionally been lacking, despite obvious fact that patients being treated for common mental disorders by health care system are same people suffering effects of depression in their role as workers. It has been observed that the worlds of mental health and work have elaborated two cultural traditions, speak different languages, are philosophically (8). The time is right to make substantial change in way that health care and occupational domains collaborate to manage workplace depression (9). We need to establish a bridge between mental health care and workplace. This issue includes 2 articles concerned with workplace mental health, each contributing to bridging worlds of mental health care and workplace but in distinct ways. The first article, by Dr Kristy Sanderson and Dr Gavin Andrews, systematically reviews empirical research concerning relation between workplace factors and common mental disorders (mainly depression and anxiety) (10). The authors focus on methodologically sophisticated studies with large samples. The variables used to reflect both workplace disability and causal factors are complex and overlapping; however, Sanderson and Andrews provide clear definitions, making it easier for clinicians and researchers not working in this area to understand their findings. A notable finding of their review is that most individuals with common mental disorders are in fact at work, despite their symptomatology; many of them suffer some degree of presenteeism, working at a reduced level of productivity. Further, authors show that certain kinds of workplace environments increase risk of onset of common mental disorders. One such risky environment provides jobs with high demands, whether because of long hours or intense time pressure, but with little control permitted to employees regarding nature or timing of tasks. A second type of risky environment is one in which employees do not perceive job rewards to be equal to effort required and thus find work situation demoralizing. A third recently identified type of risky environment is one in which workplace is experienced as fundamentally unjust, whether in terms of unfair decision making or disrespectful treatment by managers. This review also identifies increased risk associated with atypical employment, that is, with jobs that are not permanent (whether part-time, casual, or with some other transient arrangement). Having determined major sources of workplace risk, authors suggest system-level interventions to improve workplace environments and, hopefully, reduce their contribution to mental disorder. …

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